(1) University of Kansas Medical Center, Kansas City, KS, U.S.A.
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Venous thromboembolism carries a high rate of in-hospital mortality, and pulmonary embolism is the third most common cause of cardiovascular death, with more than 600,000 cases occurring in the United States annually. The indications and use of thrombolytic therapy in the treatment of acute PE is highly controversial, especially regarding its use in the setting of sub-massive pulmonary embolism. This review discusses the risk stratification of patients with pulmonary embolism, outline prognostic factors, and discuss current recommendations and controversies regarding both systemic and catheter-directed thrombolytic use.
The use of thrombolysis, either catheter-directed or systemic, in sub-massive pulmonary embolism, remains controversial at this time.